HEALTH GUIDE for SINGAPORE WELCOME to SINGAPORE — What You Need to Know About Healthcare Here When Moving to a New Country, It Is Normal to Have a Mixture of Feelings

International Doctors Caring for You

HEALTH GUIDE FOR SINGAPORE WELCOME TO SINGAPORE — What you need to know about healthcare here When moving to a new country, it is normal to have a mixture of feelings. You may feel excited at the thought of all the new experiences you will have, but you may also have concerns about some of the practical issues such as healthcare. This may be a particular concern for those who are living in Asia for the first time, for people who have chronic health problems and for families with young children.

The good news is that medical practice in Singapore is of a very high standard. It is generally modelled on the British system, and doctors have standard compulsory university degrees with hospital training. Specialist doctors often have their further training in the United Kingdom, North America or Australia. EMERGENCIES

Accident & Emergency (A&E) Departments at the hospitals are open 24 hours and have access to “on-call” specialists. They can be more expensive and very busy, and should be used only for emergency care.

Private ambulance: 6272 6018 Please note that 995 for emergencies will call the government ambulance that Non-emergency ambulance: 1777 takes you to the nearest government Singapore Civil Defence hospital A&E Department. You may ambulance: 995 then request transfer to a hospital of your choice.

Police: 999 To go to a private hospital phone the A&E department of that hospital and you can request an ambulance to take you there. Generally the ambulances Fire: 995 drive at the same speed as the traffic, and may not run their sirens. If the person can walk it may be quicker to go by car or taxi.

We urge you to enter these numbers into your mobile phone now.

HOSPITAL CONTACTS

North

Mount Alvernia Hospital Tan Tock Seng Hospital Phone: 6347 6688 Phone: 6256 6011 A&E: 6347 6210 A&E: 6357 8866

Khoo Teck Puat Hospital Thomson Medical Centre Phone: 6555 8080 Phone: 6250 2222 A&E: 6602 2574 A&E: 6350 8812 Ambulance: 6445 7300

South

Singapore General Hospital Phone: 6222 3322 A&E: 6222 5757 East

Changi General Hospital Parkway East Phone: 6788 8833 Phone: 6344 7588 A&E: 6850 1680 A&E: 6340 8666 Ambulance: 6473 2222

West

National University Hospital Ng Teng Fong Phone: 6779 5555 Phone: 6716 2000 A&E: 6772 5000 No A&E number available

Central

Gleneagles (Orchard) Mount Elizabeth (Novena) Phone: 6473 7222 Phone: 6933 000 A&E: 6470 5688 A&E: 6933 0100 Ambulance: 6473 2333 Ambulance: 6473 2222

KK Women’s & Children’s Hospital Mount Elizabeth (Orchard) Phone: 6225 5554 Phone: 6737 2666 A&E (child): 6394 1177 A&E: 6731 2218 A&E (women): 6394 1190 Ambulance: 6473 2222 Ask-a-Nurse Service: 1900 556 8773

CHECK VACCINATIONS

We urge you to check your family’s immunization status. These are the diseases that you can be vaccinated against. A consultation with your doctor is always necessary as requirements differ between individuals:

Highly Recommended May be Needed in Certain Cases • Diptheria/Tetanus/Pertussis • Rotavirus (whooping cough) • Seasonal Influenza • Polio • Varicella (chickenpox) • Haemophilus influenza Type B (Hib) • Human Papilloma Virus (HPV) • Measles, Mumps and Rubella (MMR) • Meningococcal B • Hepatitis B • Meningococcal C • BCG (Tuberculosis) • Pneumococcal 23 • Pneumococcal FOOD AND WATER IN SINGAPORE

Generally eating/drinking in Singapore is free of the usual risks that are associated with life in Asia, however there are a few important things to be aware of. MSG Water Monosodium Glutamate (MSG) is an The water supply in Singapore is of additive added to a number of foods a high quality, suitable for drinking here as a flavour enhancer. Ingestion can and is optimally fluoridated. Fluoride produce symptoms such as aches, pains, pins and needles, headache and tingling. works in two ways. Firstly, on the un- Treat by drinking plenty of water. erupted developing adult teeth in your child and secondly, on the teeth that Beef have already erupted into the mouth. Evidence has shown that the contact Beef is generally imported from Australia of fluoride with the teeth is the most and New Zealand. important preventive measure.

HEALTH HAZARDS IN ASIA

Humidity

Singapore is very hot and humid, One of the other problems with heat and with this climate one can easily and humidity is a slower healing time become dehydrated. Given this, it for cuts/scratches and bites. Cold is important to drink plenty of fluids and flu symptoms tend to hang on especially if involved in outdoor longer and general fatigue can be a activities. It is advisable to always common problem. have a water bottle with you for Other common problems are ear, children as they are at particular risk. eye and fungal infections (often due to the length of time spent in the swimming pool)!

Haze In recent years, forest fires in neighbouring countries have caused haze to blanket the region.

The fine particles in the haze may Children and the elderly are more cause irritation to the eyes, nose, likely to be affected. Exercising in throat and airways. People with chronic the haze may lead to worsening of lung illnesses, asthma, allergic rhinitis, these conditions. sinusitis and allergic skin conditions may experience exacerbations of their conditions. The Pollutants Standards Index (PSI) and PM 2.5 is used as an indicator of the severity of haze and can be found on the NEA website (www.nea.gov.sg).

PSI (24-hr)

0 Good (up to 50) No action required 50 Moderate (51-100) No action required 100 Unhealthy (101-200) Reduce vigorous outdoor activity. Those with existing heart or respiratory ailments should reduce physical exertion and outdoor activity. 200 Very Unhealthy (201-300) Avoid vigorous outdoor activity. The elderly and those with existing heart or lung diseases should stay indoors and reduce physical exertion and outdoor activity. 300 Hazardous (above 300) Avoid all unnecessary outdoor activity. Children, the elderly and those with existing diseases should stay indoors >300 and avoid physical exertion and outdoor activity.

Skin Care in the Tropics Skin disorders can be more common in the tropics. Babies especially are frequently troubled by heat rashes but, dressing in natural fibres and loose clothing can prevent this.

In this tropical region the intensity The shortest wavelength, ultraviolet of the sun’s rays is strong, and the B (UVB), is mainly responsible for development of premalignant and the premalignant and malignant skin malignant skin tumours and skin changes. Longer wavelength ultraviolet ageing are long-term side effects A (UVA) is responsible for photo-ageing of ultraviolet exposure. of the skin (i.e. dry skin, wrinkles, loss of elasticity and uneven pigmentation), and some forms of cancer.

Who is most at risk? Genetic factors influence susceptibility to cancer. People who have many pigmented moles (more than 50) and those with irregular moles have an increased risk. There is now good evidence that sunburn incurred before the age of 15 increases the risk of melanoma developing in later life. How to minimise sun-induced skin damage?

Avoid the midday sun Wear appropriate clothing and hats

Seek natural shade Regular and adequate application of a broad-spectrum sunscreen with a sun protection factor (SPF) of 30 or above

Sun Protection

Excessive sun exposure is a health Vulnerable groups are babies and hazard due to the effect of ultraviolet children, fair skinned people, those radiation on the skin. Sunburn can with albinism or previous skin cancer, range from redness to blistering. and those on medications such as Besides sunburn, ultraviolet radiation tetracycline. can also cause pre-mature skin cancers.

Insect Avoidance

Insect bites, apart from being a Residents are advised that they nuisance, may spread diseases like can reduce their risk by remaining in dengue fever and malaria. Bites may well-screened or air-conditioned areas also get infected, requiring treatment when possible, wearing clothing that with antibiotics. adequately covers the arms and legs, and applying insect repellent to both skin and clothing.

Insect repellents which are available from IMC are:

1 Contack-II (Permethrin Concentrate)

Contack-II (Permethrin Concentrate) is an odourless insect killer and repellent for soaking uniforms and clothes. It is the first line of defence against biting insects. Upon contact with permethrin- treated clothing or garments, the insect will fall off almost immediately. Most will die from this brief contact.

2 DEET Deet based insect repellents provide exceptional long-lasting protection from biting insects and have been used by hundreds of millions of people around the world since the 1950’s. Our range of Australian made Deet repellents are safe to use, feel and smell great on the skin and come in convenient travel-friendly packaging. With DEET concentrations ranging from 10% - 80%, you’ll find the right product for the whole family. Please note DEET is not recommended for use on infants under 2 months of age.

3 Picaridin Picaridin based insect repellents can be a great alternative for DEET-sensitive individuals. They provide safe and effective protection from biting insects and we have products to suit the whole family. Dengue Fever Dengue fever is present in Singapore. It is a viral infection with flu-like symptoms, spread by the Aedes mosquito, unlike malaria mosquitoes they can be found in the city area in daylight hours. There is no treatment and the disease can be serious. A dengue vaccine is now available but it is mainly for patients who have had a previous bout of it.

Dengue viruses are found in many countries of the Caribbean, Central and South America, Mexico, the Pacific Islands, most tropical countries of Asia and parts of tropical Africa.

Cases of Dengue Fever in most Dengue Haemorrhagic Fever is a rare tropical areas have increased in but potentially fatal complication of recent years. Major outbreaks have Dengue Fever. This is more common in occurred in the Pacific region and in India and Southeast Asia, particularly North Queensland (Australia). amongst those who have had dengue fever before.

The symptoms

Fever, severe headache, joint and Any persons suspected of having muscle pain, rash and sore throat - dengue fever should be observed usually appear 5-8 days after being for signs of bleeding or bruising and bitten by the offending mosquito. seek urgent medical attention if this The rash, which develops on the 3rd happens. Diagnosis is by blood test. to 5th day of the illness, spreads It is usual practice to monitor the from the stomach to the arms, platelet count until full recovery. legs and face. A few days after the This may require repeat blood tests. rash appears, the fever breaks and recovery begins.

Prevention

Prevention by mosquito avoidance Also, remove stagnant water around measures is the most effective action the home (e.g vases), and note that e.g. insect repellent and mosquito nets. the risk is higher with a house and garden.

Anti-malarial tablets do not offer any protection against dengue fever. Insect avoidance measures offer the best protection against dengue. Chikungunya Fever Chikungunya fever is a viral disease transmitted to humans by the bite of an infected mosquito (Aedes mosquito).

The disease is endemic in many parts of the tropics. Outbreaks have occurred in recent years in Africa, Southeast Asia, South Asia (e.g. India and Sri Lanka), and the Indian Ocean islands.

Imported cases of chikungunya fever have also been reported in Europe, US, South America and Asia amongst travellers returning from chikungunya fever affected areas. The first outbreak of this disease in Singapore was in January 2008. There is no effective vaccine for the prevention of chikungunya fever.

The symptoms

The symptoms include a sudden The illness is usually self-limiting. onset of fever, chills, headache, Most symptoms last for 3-10 days nausea, vomiting, joint pain with or and the joint pain may last for weeks without swelling and low back pain. to months. Some patients may develop a rash affecting the trunk and limbs.

Prevention

Chikungunya fever, like dengue fever, is a mosquito-borne disease and the best way to prevent chikungunya fever is to take precautionary measures to prevent mosquito breeding around the house and to protect against mosquito bites.

Hand Foot & Mouth Disease A very common infection seen in young children. Hand, foot and mouth disease (HFMD) is usually a mild illness with resolution seen within a week.

The symptoms

Typically seen are ulcers in the mouth Feeding can be painful and in the and small blister-like rashes on the young child careful attention to palms, soles and bottom. hydration is needed.

Prevention

Avoiding close contact with other young children and careful hand washing is important to prevent spreading the disease. Singapore requires avoidance of daycare and public places for 10 days post onset, and advises no swimming for 6 weeks as the virus can live longer in wet surfaces. Mycoplasma A microorganism called Mycoplasma Pneumoniae is sometimes responsible for atypical chest infections amongst older children in the community.

It is spread through infected water Because close contact is needed to droplets from coughing and sneezing, spread the organism, it is not unusual and individuals develop symptoms 2-3 to find Mycoplasma infections within weeks after exposure. families, with individuals developing symptoms weeks apart.

The symptoms

Initial symptoms are described as Most cases are suspected from the flu-like and include: fever, persistent clinical history and the diagnosis dry cough, tiredness and general body may be confirmed with a blood test aches. Whilst infected individuals are measuring the body’s antibody level usually not severely unwell, these against Mycoplasma. Sometimes a symptoms can be persistent for chest x-ray may be needed if significant weeks or even months. pneumonia is suspected.

In mild cases of Mycoplasma, symptoms are self limiting and resolve spontaneously with time. Treatment is available for persistent infections and involves taking an antibiotic for up to 2 weeks.

Prevention

There is no vaccine to protect against this organism but preventative measures like shielding the nose and mouth on coughing or sneezing and avoiding close contact in crowded areas when unwell can help reduce spread in the community.

Swimmer’s Ear/Tropical Ear Year-round swimming together with a humid environment can create the ideal conditions for the development of otitis externa, or “swimmer’s ear”. This is an infection of the ear canal caused by bacteria or fungi, and is usually treated with specific ear drops.

Prevention

Preventative measures include using ear plugs. TRAVEL HEALTH

Whilst Singapore itself is relatively free of certain tropical diseases, the surrounding areas (e.g. Malaysia and Indonesia, including Batam and Bintan) are not. Further, postings to Singapore often include extensive travel for both business people and families. It is therefore important to be aware of health issues related to regional and international travel.

TRAVEL VACCINATIONS

Vaccinations provide protection against diseases you might be exposed to during travel. For many countries no vaccinations are necessary apart from booster doses of those generally given during childhood i.e. polio, tetanus, diphtheria and possibly measles. Hepatitis A & B vaccinations are also advisable. On the other hand, a number of more exotic vaccines may be recommended for those venturing off the beaten path. Vaccinations are not the only reason to see a doctor before travelling. On average about 30-80% of travellers to developing countries will suffer a travel related illness, some with potentially serious consequences.

Recommended for travel Special Situations • Hepatitis A • Yellow fever • Typhoid • Meningitis ACWY • Influenza • Meningitis C • Cholera / Traveller’s Diarrhoea • Japanese B Encephalitis • Rabies

PRE-TRAVEL CONSULTATIONS

Pre-travel consultations offer dedicated time to prepare travelers for the health concerns that might arise during their trips.

The objectives of the pre-travel consultation are: to assess the traveller’s trip plans to empower the traveller to manage and determine potential health hazards his or her health throughout the trip

to provide immunizations for vaccine- to educate the traveller regarding preventable diseases and medications the anticipated risks and methods for prophylaxis, self-treatment, or both for prevention

Medical advice should be sought at least 4 to 6 weeks before departure but it is never too late to seek advice! DRINKING & EATING SAFELY

Where sanitation is poor, drinking water or food can easily become contaminated with organisms that have unpleasant effects on our gut. Travellers need to be more careful with their personal hygiene habits when staying in less developed areas than when they are at home in a ‘safer’ environment. A simple and effective way of decreasing the ingestion of unwanted organisms is to wash hands with soap prior to eating, or to use an alcohol hand rub. Other considerations include:

Drinking • Assume all water is contaminated (this does not apply in Singapore) • Never use ice unless you know it has been made from safe water (this includes luxury hotels in areas of concern) • Boil water for 5-10 minutes. This is the most effective way to make sure water is safe • If safe water is unavailable, use bottled or canned fluids • Use clean water (bottled or boiled) to brush teeth

Eating Do not eat the following: • Uncooked, undercooked or reheated food • Uncooked fruits or vegetables that you do not prepare yourself • Ice cream (unless it is an internationally packaged and labelled brand) and dairy products • Oysters, clams, mussels, barbecued prawns or mud-crabs • Cooked food which has been left at room temperature or exposed to flies • Dishes requiring a lot of handling to prepare

Do eat the following: • Freshly cooked (fried, boiled, steamed) food • Peelable fruits (bananas, citrus fruits, etc) • Food of acceptable brands in cans or sealed packs • Local food served in well patronised, busy restaurants • Off clean plates with clean cutlery • Food prepared by yourself

Please Note: This complimentary information booklet is provided for information only, and is not intended to replace professional medical advice. Please consult your doctor. We are Professional Our people make the difference. From making an appointment to the consultation with the doctor, IMC delivers the highest standard of professionalism throughout our patient’s experience.

We are International All our medical professionals are carefully selected and have international training and experience to deliver patients with the comfort and care they would receive at home. Our doctors come from across the world and speak multiple languages.

We are Caring Our patients are not just numbers to us, but actual people that we care for as we would our own family. We strive to provide the best care and consideration for our International Medical Clinic patients which means going the extra mile. (IMC) specialises in family, paediatric and travel medicine We are Nearby With clinics in the west (Jelita), central We have provided medical care in Singapore (Camden) and in the east coast (Katong) for over 19 years and are a recognised and we are close to your home, your office and trusted medical provider for the international your school. community. With three General Practice Clinics and a specialist Paediatric department, IMC provides a high standard of healthcare in a caring, friendly and familiar environment. OUR DOCTORS

Directors

Dr Clarice Chia Woodworth Elizabeth Cowle Medical Director Managing Director MBBS (Singapore), BSc (Melbourne, Australia), DIP Pract Derm (UK) ARPS (UK)

Jelita

Dr Lim Hui Ling Dr Navjot Uppal MBBS (Singapore) MBBS (Cardiff, UK) M Med (Family Medicine) MRCGP (UK) (Singapore), MCFP (Family Languages spoken: Punjabi Med) (Singapore) Languages spoken: Mandarin

Dr Nicole Reidy Dr Woo Boon Peng MBBS (Hobart, Australia), MBBS (Sydney, Australia) FRACGP (Australia) FRACGP (Australia) Languages spoken: Mandarin

Dr Chris Eldridge Dr Mélissandre Noël MBBS (London, UK), MD (Montreal, Canada) MRCGP (UK), FRACGP CCFP (Canada) (Australia), DRCOG (UK), Languages spoken: French MRCSEd (UK) Languages spoken: French

Dr Peter Chiu MD (Austria) Dip (Family Med) (Singapore) Languages spoken: German, Mandarin, Cantonese Based in both Jelita and Katong clinics Camden

Dr Ho Tzin Yih Dr Phua Sin Ru MB BCh (Dublin, Ireland), MBBS (Brisbane, Australia) Dip OM (Singapore) GDFPDerm (Singapore) GDFM (Singapore) Languages spoken: Mandarin

Dr June Tan Sheren Dr Valerie Druon MBBS (Singapore) MBBS (Sydney, Australia) M Med (Family Med) (Singapore) FRACGP (Australia) Languages spoken: Mandarin DIP (Family Practice Dermatology) (Singapore) Languages spoken: French

Dr Tan Lih Yi Dr Heather King MB ChB (Belfast, UK) MB ChB (Dundee, UK) DRCOG (UK), DRCOG (UK), DCH (UK), MRCGP (UK) MRCGP (UK)

Dr Vinu Sahlén Dr Neil Forrest Zweiter Abschnitt Certificate MB ChB (Leeds, UK), (Aachen, Germany), MRCS MRCGP (UK) (UK), GDFM (Singapore) Languages spoken: Swedish, German

Dr Nandini Shah Dr Sonali Dassanaike MBBS (London, UK), MB ChB (Sheffield, UK), MRCGP (UK) MRCGP (UK)

Please visit our website for detailed biographies on all our doctors. Katong

Dr Foong Tsin Uin Dr Peter Chiu MBBS (London, UK) MD (Austria), MRCGP (UK), Dip (Family Med) (Singapore) Dip Pract Derm (UK) Languages spoken: German, Languages spoken: Mandarin Mandarin, Cantonese Based in both Jelita and Katong clinics

Paediatric

Dr Leo Hamilton Dr Judy Schmidt MD (Alabama, US) MD (Houston, US) Board Cert (Paed) (US) Board Cert (Paed) (US)

Dr Bernadeta Wibisono Dr Arti Jaiswal MD (Netherlands, Antililles) MD (New York, US), Board Cert (Paed) (US) Board Cert (Paed) (US) Languages spoken: Bahasa Languages spoken: Hindi, Indonesia Spanish

OUR DIRECT BILLING SERVICES

We offer a Direct Billing Service to all our patients. This means we can bill your insurance company directly and you do not need to be troubled with paying and arranging reimbursement. Please speak to our Insurance Department to find out more. OUR SERVICES

Family Health Women’s Health

• Acute and chronic primary health care for • Health and Wellness Screenings all ages • Contraception • Adult routine vaccinations • Antenatal care • Family planning • Gynaecology – IUD procedures, Implanon and • Asthma and allergy assessment various gynae treatments • Foreign Domestic Workers Health • PAP smears • HPV testing • Sexual health

Men’s Health Children’s Health

• Health and Wellness Screenings • Child and adolescent care • Prostate checks • Childhood vaccinations • Sexual health • Child and adolescent developmental and behavioural assessments • School medicals and more

Travel Medicine Corporate Medicine

• Pre-Travel consultation and vaccinations • All Health and Wellness Screenings • Tropical medicine consultations (approved • Offshore Medicals (UKOOA) Yellow Fever clinic) • Pre and Post travel health check-ups

Minor Surgical Procedures In-House Services

• Cryotherapy for skin lesions • ECG • ‘Lumps and bumps’ procedures including • Spirometry incision and drainage • Phlebotomy • Wound care dressing • In-house medication dispensing • Stitches removal • Various in-house testing such as coagulation • Skin evaluation and mole removal check, blood sugar monitoring, pregnancy • Toe nail excision testing and urine analysis • Contraception insertion and removal • Nebuliser (including Implanon and IUD) • Ear syringing

OUR LOCATIONS

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Camden Jelita 1 Orchard Boulevard 293 Holland Road #14–06 Camden Medical Centre #02–04 Jelita Cold Storage Singapore 248649 Singapore 278628 T 6733 4440 T 6465 4440 E [email protected] E [email protected]

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D LEVA CENTRE O U D BO HAR ORC KATO NG V Katong Paediatric 86-88 East Coast Road 1 Orchard Boulevard #02-07 Katong Square #11–06 Camden Medical Centre Singapore 423371 Singapore 248649 T 6342 4440 T 6887 4440 E [email protected] E [email protected]

Make your appointment today!